Urology & Kidney Disease News Fall 2009 - Cleveland Clinic

18 Urology & Kidney Disease News
Prostate Cancer
A Nomogram for Predicting Upgrading in Patients with Low and Intermediate Grade
Prostate Cancer in the Era of Extending Prostate Sampling
Ayman S. Moussa, MD, Michael W.
Kattan, PhD, Changhong Yu, and J.
Stephen Jones, MD, FACS
The Gleason score (GS) is considered
the most important factor in characterizing
the biological potential of
a prostate cancer and plays a major
role in treatment decision making.
However, the GS assigned at biopsy
exhibits a limited correlation with the
GS assigned following radical prostatectomy
(RP). In previous studies, we
found that 50% of patients with GS
6 and 26.2 % of patients with GS > 7
experienced postoperative upgrading.
For men with biopsy GS 6 and/or 7
(3+4), it is important not to underestimate
the disease risk and to assess
the accuracy of biopsy GS in predict-
Figure 1: GS upgrade nomogram
ing the actual pathological GS. Otherwise,
patients with unrecognized
high-grade cancer may choose less
aggressive treatment options and be
at increased risk of adverse oncologic
outcomes.
To address this issue, we examined
the rate of Gleason score upgrading
between biopsy and final pathology
in a large cohort of patients and constructed
a nomogram to predict the
probability of biopsy Gleason sum
upgrading. Our objective was to provide
clinicians with a tool that could
estimate the probability of a more
aggressive prostate cancer variant,
which could suggest a change in the
selected treatment.
Key Points:
A study of 1,017 prostate cancer
patients with theoretically low
at diagnostic biopsy found that
nearly one-third will be upgraded
pathology.
Our nomogram for predicting the
probability of Gleason sum upgrading
based on multiple variables had
a predictive accuracy of 68%. It
can provide important additional
information to aid the urologist and
ing,
especially for patients considering
non-surgical options.
patients seen at our institution. Each scale
position has corresponding prognostic
-
Gleason score. For age, use age at time
-
American, (C) for Caucasian and (O) for
-
percent cancer in any core: use the current
the highest secondary grade present in the